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Sexual and reproductive health for individuals with inflammatory bowel disease

What is inflammatory bowel disease?

  • As inflammatory bowel disease (IBD) usually presents during the reproductive years, health professionals should consider SRH issues in their management of affected individuals

Treatment of IBD

  • Managed clinical care pathways should be developed locally to promote integrated working between different service providers to ensure that the SRH needs of individuals with IBD are met

IBD and fertility

What is the effect of IBD treatment on fertility?

Medication

  • Health professionals should be aware of the possible effects of some IBD medication on sperm quality and quantity, and the potential impact on male fertility

Surgery

  • The risk of subfertility following reconstructive surgery should be discussed with women with IBD and their partners

IBD and pregnancy

  • Women with IBD should be advised to plan to conceive when the disease is well controlled
  • Appropriate referral for pre-pregnancy counselling should be available for men and women in order to optimise their IBD management prior to conception

Caesarean section

  • There is controversy regarding the most appropriate mode of delivery (caesarean section or vaginal) following ileal pouch-anal anastomosis surgery. Women should be guided in their decision by the advice of the obstetric and gastrointestinal specialists in charge of their care

What is the effect of IBD treatment on pregnancy outcomes?

Medication

  • If either partner is taking methotrexate, pregnancy should be prevented by use of effective contraception during and for at least 3 months after treatment
  • If either partner is taking mycophenolate mofetil, pregnancy should be prevented by use of effective contraception during and for at least 6 weeks (women) or 3 months (men) after treatment has ended
  • The BNF advises that pregnancy should be prevented by use of effective contraception for women treated with TNF-α inhibitors (e.g. infliximab, adalimumab) and for 6 months after treatment has ended. Consideration for use during pregnancy requires specialist advice
  • Health professionals should check current NICE, British Society of Gastroenterology and European Crohn’s and Colitis Organisation guidelines, and the summary of product characteristics for each medication for specific advice on use while trying to conceive and while pregnant or breastfeeding. The decision to discontinue any treatment requires expert clinical judgement, balancing the risks of stopping the drug against the risks associated with continuing

Other considerations relating to pregnancy and IBD

  • Health professionals should consider ectopic pregnancy in their differential diagnosis of abdominal pain and gastrointestinal symptoms in sexually active women with IBD

IBD and contraceptive choice

Does contraception influence IBD?

  • Women can be informed that a causal association between combined oral contraception use and onset or exacerbation of IBD has not been established

Does IBD affect contraceptive choice?

Absorption of oral contraception

  • Women should be advised that the efficacy of oral contraception is unlikely to be reduced by large bowel disease but may be reduced in women with Crohn’s disease who have small bowel disease and malabsorption

Osteoporosis

  • Health professionals should consider the impact of IBD-associated conditions (e.g. venous thromboembolism, primary sclerosing cholangitis, and osteoporosis) as well as other medical conditions when prescribing contraception to women with IBD

How might IBD treatment affect contraceptive use?

Medication

  • Health professionals should check whether any prescribed medications for rectal or genital administration contain constituents that could reduce the efficacy of condoms

Surgery

  • Women with IBD should stop combined oral contraception at least 4 weeks before major elective surgery and alternative contraception should be provided. Advice regarding recommencing COC should be given individually
  • Previous pelvic or abdominal surgery in women with IBD could affect the safety and success of laparoscopic sterilisation
  • Women with IBD considering sterilisation—and their partners—should be counselled about alternative methods of contraception including long-acting reversible contraception methods and vasectomy

IBD, sexual function and psychosexual health

  • Health professionals should provide an opportunity for individuals with IBD and their partners to discuss issues relating to sexuality, body image and mental well-being, and know where to refer locally when appropriate

full guideline available from…

Faculty of Sexual and Reproductive Healthcare

www.fsrh.org/standards-and-guidance

Sexual and reproductive health for individuals with inflammatory bowel disease. October 2016

First included: July 2018